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Wednesday
Apr242013

Fair Fighting

There is a common misconception that healthy relationships, or happy couples "never fight."

Absolutely all couples fight, and in some ways, how and when you handle differences can be a modeling experience for your children (another misconception is "don't fight in front of the kids").

There is a noted psychologist, John Gottman who states that he can predict with almost 90% accuracy which couples will last and which will not. He does this by studying couples in his "love lab" and measuring the frequency of their fights and qualities of their fights. I suggest you look into his work, its well known and easily digestible.

For an overview of the difference between healthy and unhealthy conflict in relationships, lets talk about the concept of "fair fighting."

In a boxing ring, you lose points by hitting below the waste line, below the belt as it were. This expression is to be taken quite literally in this context, however we use the expression below the belt in common parlance and this is how it looks in the context of couples therapy:

There are a few basics that need no elaboration such as the use of violence or threats of violence, and name calling.  Also it is best to stay present focused and avoid throwing in the kitchen sink. If you are discussing the topic that he forgot your birthday, it is unhelpful to throw in that last week he embarrassed you in front of your friends and that time that he made plans to go to the football game after you discussed the need to stay home and have a weekend of relaxing and cleaning around the house. When people feel bombarded and attacked they tune out or go into attack mode in response. Dumping a mountain of grievances only serves to help you unload, it will have no effect on changing his behavior.

This leads to another related idea, to let things go. If you have come to a resolution or conclusion on a particular topic, you are not allowed to trot it back out at a future point. Lets say you have discussed openly and honestly that you feel invisible when she pays attention to others at a party. If this has been discussed, explained and the issue is closed, you cannot then bring it back out 6 months from now. If it truly isn't a closed issue then re-address it at a different time, talk to a therapist, journal about it and so forth. If you say it is closed, it needs to be closed.

Last, never withdraw or withhold sex or threaten to. Physical contact and sexual intimacy are a vital profound nourishment to a relationship. Make no mistake, healthy relationships are about more then sex, however physical intimacy is like the food and water your relationship thrives upon. Also, because of the inherent vulnerability, sex is connected to a very primal part of our being. Therefore if sex is used as a weapon, our bodies or "old brains" (see previous post) respond as if we are being starved to death. Nothing productive can come out of this and certainly a regressed vulnerable position it is no place to come from when addressing adult complex issues.

The above information is part of a longer tip sheet which I use in working with couples. If you are interested in this or any other of my tip sheets, please contact me and Ill be glad to send them your way.

Tuesday
Mar192013

How Do You Know For Sure?

When doing an assessment or an evaluation it can be difficult to identify a persons truth. We have all heard the expression (most often associated with a lie detector test) "It's not a lie if you believe it."

This is most difficult in dealing with people who struggle with addictive behavior, because denial and minimization (not to mention outright lies) are integral to the process. To be sure these tendencies (denial minimization and lies) aren't always outwardly expressed. For certain, those who engage in addictive behaviors tell themselves many stories that are far from the truth as a means to continue the behavior. "It's not that bad," "I'm not as bad as so and so," and "I'll stop when I ______" are common self perpetuating lies.

In working with loved ones of addicts I spend much time convincing them not to take it personally when they are lied to. I am not making the case that it is ok to lie, I am merely suggesting that maintaining this lifestyle always involves a measure of deception and if a person lies to themselves, they will lie to you (and me, the therapist) too.

So, for example, I suggest to loved ones that they trust their gut and rely upon open ended rather than closed ended questions. Closed ended  questions require specific numerical or yes no answers. "Did you drink today?" is a closed ended question which invariably results in a lie. (To an addict, there is a 50/50 chance that you will believe the answer, therefore it is in his/her best interest to lie).

When I interview people or attempt to perform an accurate evaluation, I use open ended questions such as "What does it feel like when you drink?" I also look for attitudes and behaviors that correlate with honest living. Questions that evaluate a person's values and attitudes around anxiety, interpersonal relationships, frustration tolerance, sensation seeking, justice, dealing with conflict and social skills are all part of this process. There are also many validated instruments or tools that can be used (my favorite one is called the RIASI.

Last, but not least, are the use of toxicology screening tools and group therapy. Using a lab to test for the presence of drugsbears much more weight then a person's word. It is near impossible to hide out, or hide from your "true self" in group therapy. The interpersonal interplay invariably brings out people's character traits, personalities and value systems, whether they are consciously aware of it or not.

So, do I (or anyone for that matter) know with 100% certainty if a person has an addiction problem?

Not quite.

I don't think error-free is the bar that we should set, this is unrealistic.

But with the aforementioned process, we can be pretty darn sure.

What do you think?

Friday
Feb012013

Adversity Moderation

I read recently in a journal article of the many disadvantages poverty bestows upon people. As this was an educational journal, the focus was on the academic performance of poor kids versus middle class and rich kids. The point of it, I think, was that positive character traits are just as important as scholastic ability and that, in fact, positive character traits contribute to scholastic ability. The second point of the article was that both rich and poor kids are at a disadvantage when it come to positive character traits.

Let me explain. Kids that grow up in poverty tend to have a sustained period of stress and anxiety which has long-term negative impact upon them.  They are more likely to live in a one parent household, witness violence, have poor dietary habits and deal with care givers who have psychiatric or substance abuse problems. Because the primary caregiver(s) of these children are also under constant stress and may be  limited and impaired, they are unable to provide a consistent safe nurturing environment for the child. These kids have constant adversity with little or no healthy support.

Kids that grow up in rich families tend to be pushed in the direction of academic and financial success and tend to have many advantages that middle class and poor children do not have. However one great disadvantage is that they rarely have adversity of any kind.

Therefore poor kids have constant adversity with no coping skills and rich kids have no adversity with no coping skills and adversity, within certain parameters, is character building. As with most things, extremes are unhealthy and so if I will use the term "adversity moderation."

It cannot be emphasized enough, the importance of "good enough parenting." Children who experience inconsistent, neglectful or abusive parents are almost certain to reap the consequences when they get older.

So the way to build positive character within our children is to give just the right dose of love support nurture and safety along with allowing them to scrape their knees, problem solve and develop coping skills; adversity moderation.

* Please note:

1-I do not claim that all poor kids have constant adversity and all rich kids do not, nor do I imply all poor and rich parents are bad parents.

2-In using the term "adversity moderation" I imply allowing adversity that is age, context and content appropriate and it always being a teachable experience.

Friday
Dec142012

Happy Holidays?

The one  thing that seems to be a common theme amongst people I work with is dread in regard to the holidays.

Those of us who work in the field of mental health or addiction are well aware of the fact that this time of year is high risk for relapse. For many, feeling alone and lonely is a big part of this process, particularly if it seems that everyone else is having a wonderful time with loved ones. On the other side of the coin, people who celebrate with friends and family often struggle with expectations and personalities.

It is very common to feel self doubt or insecurity around those closest to us, particularly those who have known us for a very long time. There is a very "normal" psychological process that takes place in which people regress either in subjective internal feelings or in corresponding behaviors, when around their family. The expression "home for the holidays" refers not only to literally visiting your childhood home, but a revisiting of old feelings habits and behaviors when around people who have known us since childhood.

I am always amazed at the transformation that takes place right in front of my eyes when I have had loved ones, especially parents, of adult clients in to see me for a "family session." I know that what is taking place is re-play of all the stored memories and feelings and a dynamic that is like a well worn path through the woods.

It is impossible not to feel like a child in the presence of your parents or elders, and it is impossible for them not to see you in such a way, even though there are layers of age and life experience superimposed on top.

So please think about this as you prepare your holiday plans. Yes, it may be true that mom is a loudmouth and uncle Ted is annoying but a big part of the dread you are feeling is your "inner child" being stirred out of its long repressed slumber in preparation to re-engage in the old dance with the familiar players.

Some things you can do to cushion the psychic blow:

1-Accept that it is a normal response to feel this way in this circumstance.

2-Remind yourself that you are a good, competent, mature, rational adult, regardless of whatever feelings you are experiencing.

3-Call upon your support network (current friends, spouse, recovery network, therapist) to discuss your feelings and reaffirm your highest self before during and after particular holiday events.

4-"Put the bat away." Make healthy self care decisions and do not beat yourself up for whatever outcomes come your way. If you institute healthy boundaries out of self care, you are being a responsible person, if others cant deal with that, it is their problem, not yours.

Examples of healthy boundaries may include not consuming alcohol, not engaging in gossip, not pointing out others faults, spending time with a spouse or other "healthier" people during a get together, skipping a get together, taking periodic breaks by either going outside for fresh air, making a call to your support network or slipping into the bathroom.

5-BREATH!  So often when we are anxious, keyed up or tense we breath fast and in a shallow manner, this in turn makes us feel physically more anxious which then reinforces anxiety producing thoughts and self talk. It a vicious cycle. Practice slow deep breathing that starts from your back and stomach and moves its way up your chest. Hold it for 5 seconds, then let it out slowly. Repeat and slow down both the air intake and output process. Do this as a regular part of your daily routine, and in particular before a holiday even so that your are more cognisant of your breathing during the event.

My overall message is to be kind to yourself, everyone feels regressed and stressed around the holidays, there is nothing wrong with you. There is also nothing you can do about the other people who cause your distress. Beware of expectations of others, they easily lead to disappointment, resentment and anger. You can, however, take care of yourself and be kind to yourself and re-frame your thinking and self-talk.

All the best in 2013!

Friday
Nov092012

Beware of Distorted Thinking

For those of us living in the North Eastern part of the United States, there may be a tendency to think quite negatively. As you may know we have been hit by both a hurricane and a blizzard in the space of two weeks.

At times like these, there is an understandable tendency to fall into un-healthy, un-helpful thinking patterns. As I have mentioned before, I suggest you become more aware of your thinking patterns and self talk patterns because they have an effect on your outlook and attitude.

For sure, there is lots to be upset about, people have lost their lives, some are still without power for the last 11 days and there are long lines for gas. However, we can easily get into thinking patterns that, as far as I am concerned, add insult to injury. It is easy to fall into such thinking patterns. Here are a couple:

Overgeneralizing- Making general statements based upon specific incidents. This is the tendency to think that once something bad happens it will always happen again.

Catastrophizing- Expecting disaster. This is a habit of thinking in a worst case manner.

Fallacy of Fairness- Expecting fairness. This is when we believe or expect that life should be fair and that people should be fair  and become sullen disappointed or enraged when this turns out not to be true.

Let me reiterate, all of these thinking tendencies are very normal and typical, particularly in the face of adversity or negative circumstances. There are those of us who tend to be oriented towards this way of thinking anyway (possibly based on genetic predisposition or negative childhood experiences). It is important to become aware of these habits and re-frame them.

This is doubly important for those dealing with addictive behaviors. Addiction thrives on negative thinking and resentment, this is like steroids for addictive thinking. Being in this position puts a person in a one-down, victim type of position and when you feel victimized or life is unfair or "poor me" it is only a very small step to justifying unhealthy behaviors.

I'm sorry to tell you this, but life can be incredibly unfair at times and people can be cruel selfish and hurtful. Sometimes there is a hurricane and a blizzard in the same week. We cannot change this. However we can become aware of our distorted thinking habits that, like drinking poison, will not only not help, may actually hurt you. We can re-frame our distorted thinking into a more reality oriented pattern; changing "I hate this weather I cant take it, I wont be happy until it's Spring" to "This is very inconvenient, I'm glad I am able to tolerate discomfort, so many people have it worse off then me, this too shall pass."

If it sounds corny to you-I submit this-You cannot change the weather, you can change your mental digestion from poison (distorted thinking) to orange juice (rational thinking).

Its your choice...